The use of dextroamphetamine to treat obesity and hyperphagia in children treated for craniopharyngioma

Background: Obesity and attention difficulties are known complications following surgical treatment for craniopharyngioma. Treatments to date have been largely disappointing. Objective: To examine the use of the central nervous system stimulant dextroamphetamine sulfate to regulate appetite and subsequent weight gain in children treated for craniopharyngioma. Setting: A multidisciplinary clinic specializing in pediatric brain tumors. Patients: Five consecutive patients with significant weight gain and poor attention following surgical treatment for cramiopharyngioma were selected for the study. Intervention: Children enrolled in the study were treated with dextroamphetamine, and growth, laboratory, and behavioral assessments were conducted for 24 months. Results:Mean+/-SD body mass index (weight in kilograms divided by height in meters squared) increased from 21+/-3.5 before the operation to 32+/-2.8 by the start of the protocol. Body mass indices remained stable throughout the protocol. No changes were observed in insulin levels or caloric intake, but the children were more active when taking dextroamphetamine. Parents noted a significant improvement in hyperactivity (mean+/-SD, 1.2+/-0.4 to 0.6+/-0.2; P=.05), scored with the Conners Parent and Teacher Rating Scales. Teachers noted a similar improvement. Conclusions: During dextroamphetamine treatment, weight gain stabilized in children who had experienced obesity following surgical resection for craniopharyngioma. In addition, parents and teachers noted significant improvements in children's overall activity and attention. Further studies are needed to determine if the improvements are stable and if earlier intervention can prevent the initial obesity.